James A. Dyer

Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control.

OBJECTIVES This study examined how immunization-related beliefs, attitudes, and perceived control mediate up-to-date immunization among various sociodemographic groups. METHODS Statewide estimates of immunization rates among children up to the age of 2 years were obtained via a multistage cluster sample. In-person interviews were conducted with 4832 parents. Information about immunization was obtained from official records or from health care providers. RESULTS Differences in immunization among sociodemographic groups were mediated by beliefs about objective barriers to immunization, protection, medical contraindication, safety concerns, distrust, and natural immunity. Protection beliefs contributed to positive attitudes toward immunization; beliefs in natural immunity and safety concerns contributed to negative attitudes. Beliefs about objective barriers, distrust, safety concerns, and medical contraindications influenced perceived control over immunization. Positive attitudes and a strong sense of control contributed to higher immunization rates. CONCLUSION These findings provide a basis for efficient educational campaigns by specifying which beliefs should be bolstered (because they facilitate proper immunization) and which should be targeted for change (because they hinder proper immunization) in various sociodemographic groups.

Citizen Contacts with Local Governments: A Comparative View

The relationship between area social well-being and the extent of citizen-initiated contacts with local governments is examined for Dallas and Houston. The findings of this study, negative linear relationships between social well-being and contacting, are compared and contrasted with those of Jones and associates (1977) who, studying Detroit, found a parabolic relationship between social well-being and contacting behavior. The needs/awareness model developed by the Detroit researchers is expanded and elaborated using the findings of the present study. The Dallas-Houston results indicate that the empirical distribution of contacts necessary to fit the needs/ awareness model for Detroit is not universally applicable. Several explanations for this difference are examined-principally that the effect of the awareness function may be reduced and that the range of variation of the social well-being indicator may be restricted in some environments. It is further suggested that simple changes in the institutional structure for receiving contacts may alter the pattern of requests and make the distribution of contacts more reflective of citizen need than of citizen awareness.

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items

BackgroundTo test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses. In addition, these analyses may shed light on the possibility of gathering functional information that can span the life course as well as spanning different care settings.MethodsAnalyses included testing the internal consistency, predictive, concurrent, discriminant and construct validity of two activity limitation scales. The scales were developed using assessment data gathered in the United States of America (USA) from over 2,700 assessments of children aged 4 to 20 receiving Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, specifically Personal Care Services to assist children in overcoming activity limitations. The Medicaid program in the USA pays for health care services provided to children in low-income households. Data were collected in a single, large state in the southwestern USA in late 2008 and early 2009. A similar sample of children was assessed in 2010, and the analyses were replicated using this sample.ResultsThe two scales exhibited excellent internal consistency. Evidence on the concurrent, predictive, discriminant, and construct validity of the proposed scales was strong. Quite importantly, scale scores were not correlated with (confounded with) a childs developmental stage or age. The results for these scales and items were consistent across the two independent samples.ConclusionsUnpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individuals life course.

Testing Telephone and Web Surveys for Studying Men's Sexual Assault Perpetration Behaviors

Three pilot studies were conducted to obtain information about sexual assault perpetration from adult men in the United States. Each used the same random digit-dial sampling and recruitment strategy. One pilot was administered by telephone and two via the Web. Response rates in all pilots were low. Although results cannot be generalized beyond the sample, of the 97 men who completed the surveys, approximately 40% in each pilot reported some sexual assault behavior, broadly defined. Contrary to expectations, telephone respondents reported a wider range of sexual assault behaviors. Suggestions for improving response rates include offering a choice of participation methods.

Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community

Purpose. Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home. Methods. Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA. Results. Analyses revealed that assessments of CSHCN with the greatest or least amount of activity limitations exhibited the greatest agreement. The greatest disagreement occurred when assessors faced children with moderate to moderately severe activity limitations. Specific ADLs, where the greatest and least agreements occurred, varied by the level of the childs overall activity limitation. Conclusions. These results imply that the most serious challenges to the reliability of home-based assessment of ADLs among CSHCN occur in cases of children with moderate or moderately severe activity limitations.

Substance Use in Urban and Rural Texas School Districts.

The aim of this study is to compare substance use between urban and rural secondary school districts in Texas between 1998 and 2003. The differences were analyzed using chi-square and analysis of variance. The analysis found that rural schools had students who reported higher rates of use of tobacco, frequent binge drinking, and driving while drunk and urban schools had students who reported higher rates of use of marijuana and driving while ‘stoned.’ However, the gaps in illicit drug use and drug use attitudes between urban and rural districts may be closing. Compared to 1998–1999, differences in perceptions of dangerousness and parental disapproval of use had narrowed by 2002–2003. This trend in rural use may be due to the fact that the percentage of rural schools providing drug education had decreased to levels similar to urban schools.

Bureaucratic Response to Citizen Contacts: Neighborhood Demands and Administrative Reaction in Dallas

The present study examines bureaucratic response to all citizen-initiated requests for service from the Dallas city government for January-December 1975. Utilizing this expanded data base, the authors test hypotheses derived from the three basic models proposed to explain bureaucratic response to citizen requests for service: the political model, the underclass model, and the bureaucratic decision-rule model. The study finds little support for either the political or the underclass model and some empirical support for the bureaucratic decision-rule one. In addition, the study finds significant variations in the contacting response relationships across categories of contact, strongly indicating that researchers must be careful in their generalizations about contacting response when small samples or single-category studies are the basis of the analysis.

Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services

BACKGROUND Medicaid Personal Care Services (PCS) help families meet childrens needs for assistance with functional tasks. However, PCS may have other effects on a childs well-being, but research has not yet established the existence of such effects. OBJECTIVES To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services. METHODS Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services. RESULTS For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use. CONCLUSIONS Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a childs well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family.

New Voters, Switchers, and Political Party Realignment in Texas

ECAUSE political parties play such an important stabilizing and directing role in American politics, scholars and practitioners pay close attention to the relative strengths of our two major parties. They look especially for signs which might indicate any change in party balance which could signal changes in America’s public policy agenda. Party realignments are complex phenomena. Ladd (1986) argues that the

Ballot Access Requirements in Congressional Elections

Ballot access laws attempt to limit the number and type of candidates who qualify to have their name appear on official ballots. A study was conducted of the relationship between the difficulty of access requirements and the number of congressional candidates from 1968 through 1976. Incumbency and electoral margin also were used as predictor variables. Ballot access requirements helped to explain the number of candidates running in House elections but not for the Senate contests. Incumbency and electoral competition variables were found to influence candidate competition for both houses in the primary but only for the House in general elections. Although the ballot access requirements have some effect on the opportunities for candidacy, the political factors have an independent effect which may be more important than the formal requirements in some circumstances.